The impact of past surgical history on postoperative outcomes following primary total joint arthroplasty: a retrospective study
Michelle Shimizu
, Daniel Estrada, Hanna House
, Jackson P. Tate
, Rob Hand, Timothy DeRolf, Nicholas Brown
, Harold Rees
Contributions: (I) Conception and design: N Brown, H Rees; (II) Administrative support: N Brown, H Rees; (III) Provision of study materials or patients: M Shimizu, D Estrada, H House; (IV) Collection and assembly of data: M Shimizu, D Estrada, H House, JP Tate; (V) Data analysis and interpretation: R Hand, T DeRolf; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Background: Currently, there is little data regarding a patient’s prior surgical history on postoperative outcomes following primary total joint arthroplasty (TJA). Literature has indicated that surgical timing affects postoperative outcomes, with wait times possibly affecting patient recovery, function, and quality of life. The aim of this study is two-fold: (I) to identify the optimal length of time to wait following a surgical procedure prior to performing primary TJA, and (II) to determine the relationship between the number of previous surgeries within the year of a TJA and its effect on postoperative outcomes.
Methods: Charts of all patients who underwent primary TJA between 2007 and 2021 at Loyola University Medical Center and affiliated hospitals were manually reviewed. Demographic variables were collected and analyzed. Time between surgeries was assessed. Primary postoperative outcomes included the 90-day complication and readmission rate.
Results: A total of 3,155 patients who underwent TJA between 2007 and 2021 were included in the study. When looking at surgical history, 12.3% of patients without prior surgeries, 8.7% with one prior surgery, and 11.5% with multiple prior surgeries within the past year, respectively, experienced postoperative complications. Using multivariable regression analysis, there was no significant difference in the odds of having a complication following index surgery between patients with no prior surgeries compared to multiple prior surgeries within the year (odds ratio =0.80, 95% confidence interval: 0.43–1.5; P=0.5).
Conclusions: These findings suggest the number of previous surgeries within the year and their timing is not associated with an increased risk of postoperative complications following TJA.
Keywords: Surgical history; total knee arthroplasty (TKA); total hip arthroplasty (THA); readmission; post-operative complications
Received: 19 August 2025; Accepted: 17 March 2026; Published online: 27 April 2026.
doi: 10.21037/aoj-25-59
Highlight box
Key findings
• There was no difference in the odds of having a complication after primary total hip or knee arthroplasty in patients with no prior surgeries compared to those with multiple prior surgeries within the year. Time between prior surgeries and arthroplasty procedures also did not affect complication rates.
What is known and what is new?
• Timing of primary total hip or knee arthroplasty after a non-orthopaedic or orthopaedic procedure is shown to affect patient recovery, function, and quality of life.
• This study evaluates the optimal timing before undergoing primary total hip or knee arthroplasty after a surgical procedure.
What is the implication, and what should change now?
• The number of previous surgeries within the year and their timing in relation to a total hip or knee arthroplasty do not affect the risk of postoperative complications.
Introduction
Currently, there is little data on the impact of a patient’s prior surgical history on postoperative outcomes following primary total joint arthroplasty (TJA), defined as a primary total hip arthroplasty (THA) or a primary total knee arthroplasty (TKA). Previous literature has indicated that surgical timing affects postoperative outcomes, with wait times that are too short or too long possibly compromising patient recovery, function, and quality of life (1-5). Most studies that focus on the effect of surgical history on primary TJA have explored the optimal timing for staged bilateral TJA (6,7). Despite this, optimal timing for TJA from a patient’s most recent surgery, whether orthopaedic or not, remains a topic of debate (8-11). Some studies have investigated the effect of surgical timing between non-arthroplasty orthopaedic surgeries and primary TJA on postoperative outcomes, with inconsistent results in trends of postoperative complication rate of TJA before or after other orthopaedic surgeries in various timeframes (12-14). To our knowledge, no studies have examined the effect of a patient’s comprehensive surgical history, including timing of both orthopaedic and non-orthopaedic surgeries, on primary TJA outcomes.
The overall course of rehabilitation following surgical procedures is generally well understood. Both anesthesia and surgically induced trauma disrupt a patient’s metabolic and physiological status, inducing a stress response ultimately required for healing. However, patients remain potentially vulnerable during this postoperative time, putting them at risk for complications (15,16). Many patients undergoing surgery will experience postoperative complications, with rates as high as 30% in some groups (17). In TJA, quality improvement is increasingly important to optimize patient outcomes. In addition, many patients desire multiple primary TJAs. Hence, the impact of recent prior surgeries raises important concerns regarding optimal timing for TJA. The aim of this study is two-fold: (I) to identify the optimal length of time to wait following a surgical procedure prior to performing primary TJA and (II) to determine the relationship between the number of previous surgeries within the year of a TJA and its effect on postoperative outcomes. We present this article in accordance with the STROBE reporting checklist (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-59/rc).
Methods
Patient data
The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional review board of Loyola University Medical Center (No. 215491) and individual consent for this retrospective analysis was waived. Charts of all patients who underwent primary TJA between 2007 and 2021 at Loyola University Medical Center and affiliated hospitals were manually reviewed. Patients with revision TJA, simultaneous bilateral TJA, or partial TJA were excluded.
Variables and outcome measures
Demographic variables [age, gender, body mass index (BMI), ethnicity, race, Charlson comorbidity index (CCI)], surgical factors (indication for surgery, THA versus TKA), hospital length of stay, and surgical history within the year of index surgery (number of previous surgeries, days between most recent surgery and index surgery, and type of surgery categorized as orthopaedic or other) were collected. Index surgery was defined as the primary TJA. Surgeries were defined as any procedure that required general or spinal anesthesia. Explanatory variables included the number of prior surgeries within the year and time from most recent surgery to index surgery. The number of prior surgeries was categorized as follows: no prior, one prior, or multiple prior surgeries. Time between surgeries was assessed both as a continuous variable in number of days and as a categorical variable looking at zero to three, three to six, and 6 to 12-month time frames. Primary postoperative outcomes included 90-day complication and readmission rate. Complications included venous thromboembolism, urinary tract infection, pneumonia, myocardial infarction, sepsis, delirium, dislocation, fracture, need for manipulation under anesthesia, infection, and reoperation.
Statistical analysis
Patient demographics were presented either as a mean with a standard deviation (SD) or median with Q1 and Q3, as well as counts and percentages. Differences in characteristics between patients with and without prior surgeries were analyzed via Student’s t-tests or proportion tests as appropriate. Univariable and multivariable logistic regression were used to estimate the association between two explanatory variables with the odds of 90-day complication or readmission following the index surgery. Associations were estimated with and without adjusting for covariables. The covariables were included with each explanatory variable in the multivariable models if they improved model fit as measured by the Akaike Information Criteria (AIC) (18). The multivariable models were assessed for interaction effects and multicollinearity was assessed using the variance inflation factor (VIF). The Hosmer & Lemeshow goodness of fit test (19) was used to assess the linearity assumption of the continuous covariates and model fit was further assessed using index and bias plots of the deviance residuals. P values less than 0.05 were considered significant. Sidak multiple testing corrected P values were also applied. All analyses were conducted using R statistical software (20).
Results
A total of 3,155 patients who underwent TJA between 2007 and 2021 were included in the study. Of the patients included in the analysis, 1,232 (39%) were male and 1,928 (61%) were female. There were 922 (29%) patients with a record of a previous surgery within one year of the index surgery. Of those, 809 patients had only one prior surgery within the year at a mean of 161 days (5.3 months) prior to index surgery. Patients without prior surgeries had a lower mean CCI of 3.5 (SD =2.8) compared to a mean CCI of 4.5 (SD =3.2) for patients with prior surgeries (P<0.001, 95% CI: −0.73 to −1.2; Table 1).
Table 1
| Characteristics | No prior surgery (n=2,233) | Prior surgery (n=922) | P value | Sidak P value |
|---|---|---|---|---|
| Age (years) | 63.8 [10.5] | 64.2 [10.3] | 0.3 | >0.99 |
| CCI | 3.5 [2.8] | 4.5 [3.2] | <0.001 | 0.001 |
| BMI (kg/m2) | 27.8 [6.6] | 28.1 [6.9] | 0.2 | >0.99 |
| LOS (days) | 2 [1.7] | 2 [1.9] | 0.5 | >0.99 |
| Days since most recent prior surgery‡ | N/A | 161 (91, 252) | – | – |
| Sex (female) | 1,362 (61.0) | 551 (59.8) | 0.5 | >0.99 |
| Type of surgery | ||||
| Hip | 928 (41.6) | 311 (33.7) | – | – |
| Knee | 1,305 (58.4) | 611 (66.3) | – | – |
| Race | ||||
| White | 1,485 (66.5) | 690 (74.8) | – | – |
| Black | 426 (19.1) | 141 (15.3) | – | – |
| Other | 322 (14.4) | 91 (9.9) | – | – |
| Ethnicity | ||||
| Hispanic | 375 (16.8) | 113 (12.3) | – | – |
| Non-Hispanic | 1,837 (82.3) | 805 (87.3) | – | – |
| Complications | ||||
| Readmission | 139 (6.2) | 51 (5.5) | – | – |
| Reoperation | 35 (1.6) | 15 (1.6) | – | – |
| Any complication | 274 (12.3) | 83 (9.0) | – | – |
Data are presented as mean [standard deviation], median (Q1, Q3), or n (%). BMI, body mass index; CCI, Charlson comorbidity index; LOS, length of stay; N/A, not applicable.
At least one complication was reported in 357 (11.3%) patients following surgery. When looking at surgical history, 12.3% of patients without prior surgeries, 8.7% with one prior surgery, and 11.5% with multiple prior surgeries within the past year, respectively, experienced postoperative complications. Within the complication cohort, 23.2% of patients had undergone at least one surgery within the year, with 76.8% of patients having had no prior surgeries within the year. Of patients who had prior surgery within the year, 6.4%, 10.7%, and 9.2% experienced complications within 3 months, 3 to 6 months, and 6 to 12 months, respectively. Six-point-two percent of patients with no prior surgeries, 5.2% with one prior surgery, and 8% with multiple prior surgeries were readmitted within 90 days of the index procedure (Table 2).
Table 2
| Variables | Complications | Readmission | |||||
|---|---|---|---|---|---|---|---|
| Yes | No | Total | Yes | No | Total | ||
| Number of prior surgeries | |||||||
| None | 274 (12.3) | 1,959 (87.7) | 2,233 | 139 (6.2) | 2,094 (93.8) | 2,233 | |
| One | 70 (8.7) | 739 (91.3) | 809 | 42 (5.2) | 767 (94.8) | 809 | |
| Multiple | 13 (11.5) | 100 (88.5) | 113 | 9 (8.0) | 104 (92.0) | 113 | |
| Time since most recent surgery (months) | |||||||
| 0–3 | 14 (6.4) | 205 (93.6) | 219 | 6 (2.7) | 213 (97.3) | 219 | |
| 3–6 | 31 (10.7) | 259 (89.3) | 290 | 20 (6.9) | 270 (93.1) | 290 | |
| 6–12 | 38 (9.2) | 375 (90.8) | 413 | 25 (6.1) | 388 (93.9) | 413 | |
Data are presented as n (%).
Complications
Using multivariable regression analysis, there was no significant difference in the odds of having a complication following index surgery between patients with no prior surgeries compared to multiple prior surgeries within the year [odds ratio (OR) =0.80, 95% CI: 0.43–1.5; P=0.5]. Patients with one prior surgery had a decreased odds of having a complication compared to patients without prior surgery while controlling for age, CCI, and BMI (OR =0.66, 95% CI: 0.49–0.87; P=0.004; Table 3). Among patients with prior surgeries within 12 months of the index procedure, there was no significant association between days from most recent surgery and odds of having a postoperative complication (OR =1.00, 95% CI: 0.99–1.003; P=0.7; Table 3). Similarly, there was no significant association when looking at odds of postoperative complication between time since most recent surgery as a categorical variable at 0 to 3 months (OR = 0.65, 95% CI: 0.35–1.2; P=0.2) or 3 to 6 months (OR =1.2, 95% CI: 0.7–1.9; P=0.6) with 6 to 12 months as a reference level (Table 3). Hispanic ethnicity was associated with lower odds of postoperative complications in the subgroup models; however, this association did not remain significant after Sidak correction for multiple comparisons.
Table 3
| Variables | Univariable | Multivariable | ||||
|---|---|---|---|---|---|---|
| OR (95% CI) | P value | OR (95% CI) | P value | Sidak P value | ||
| Number of prior surgeries [zero] | ||||||
| One | 0.68 (0.51, 0.89) | 0.006 | 0.66 (0.49, 0.87) | 0.004 | 0.02 | |
| Multiple | 0.93 (0.51, 1.68) | 0.8 | 0.80 (0.43, 1.5) | 0.5 | 0.9 | |
| BMI (kg/m2) | 1.0 (0.99, 1.03) | 0.08 | 1.02 (1.004, 1.04) | – | – | |
| Age (years) | 1.02 (1.006, 1.03) | 0.002 | 1.01 (0.99, 1.03) | 0.07 | 0.3 | |
| CCI | 1.06 (1.03, 1.09) | <0.001 | 1.05 (1.01, 1.09) | 0.02 | 0.08 | |
| Sex [female] | 0.95 (0.76, 1.2) | 0.7 | – | – | – | |
| Ethnicity [Hispanic] | 0.97 (0.71, 1.3) | 0.8 | – | – | – | |
| Surgery type [TKA] | 1.0 (0.83, 1.3) | 0.7 | – | – | – | |
| Race [Black] | ||||||
| White | 1.06 (0.79, 1.4) | 0.9 | – | – | – | |
| Other | 0.98 (0.65, 1.5) | 0.7 | – | – | – | |
| Days since most recent prior surgery | 1.00 (0.99, 1.003) | 0.8 | 1.00 (0.99, 1.003) | 0.7 | >0.99 | |
| BMI (kg/m2) | 1.02 (0.99, 1.06) | 0.2 | – | – | – | |
| Age (years) | 1.01 (0.99, 1.03) | 0.4 | – | – | – | |
| CCI | 1.06 (0.99, 1.1) | 0.09 | – | – | – | |
| Sex [female] | 1.02 (0.65, 1.6) | 0.9 | – | – | – | |
| Ethnicity [Hispanic] | 0.38 (0.10, 0.83) | 0.02 | 0.34 (0.12, 0.95) | 0.04 | 0.1 | |
| Surgery type [TKA] | 1.1 (0.7, 1.9) | 0.6 | – | – | – | |
| Race [Black] | ||||||
| White | 1.66 (0.85, 3.6) | 0.5 | – | – | – | |
| Other | 0.67 (0.18, 2.1) | 0.2 | – | – | – | |
| Time since most recent prior surgery (6–12 months) | ||||||
| 3–6 months | 1.2 (0.72, 1.9) | 0.5 | 1.2 (0.70, 1.9) | 0.6 | 0.9 | |
| 0–3 months | 0.67 (0.36, 1.3) | 0.2 | 0.65 (0.35, 1.2) | 0.2 | 0.5 | |
| BMI (kg/m2) | 1.02 (0.99, 1.06) | 0.2 | – | – | – | |
| Age (years) | 1.01 (0.99, 1.03) | 0.4 | – | – | – | |
| CCI | 1.06 (0.99, 1.1) | 0.09 | – | – | – | |
| Sex [female] | 1.02 (0.65, 1.6) | 0.9 | – | – | – | |
| Ethnicity [Hispanic] | 0.38 (0.10, 0.83) | 0.02 | 0.33 (0.12, 0.93) | 0.04 | 0.1 | |
| Surgery type [TKA] | 1.1 (0.7, 1.9) | 0.6 | – | – | – | |
| Race [Black] | ||||||
| White | 1.66 (0.85, 3.6) | 0.6 | – | – | – | |
| Other | 0.67 (0.18, 2.1) | 0.3 | – | – | – | |
Variables in brackets were used as reference for univariable and multivariable statistics. BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; OR, odds ratio; TKA, total knee arthroplasty.
Readmission
No association was found between the number of prior surgeries and odds of 90-day readmission. Controlling for BMI and CCI, odds of 90-day readmission for patients with one prior surgery (OR =0.77, 95% CI: 0.53–1.1; P>0.99) or multiple surgeries (OR =1.01, 95% CI: 0.47–2.1; P=0.2) were not significant compared to patients with no prior surgeries (Table 4). Additionally, there was no association between the days since the most recent prior surgery and the odds of 90-day readmission (OR =1.00, 95% CI: 0.99–1.004; P=0.3; Table 4). Again, there was no association when looking at time as a categorical variable (Table 4).
Table 4
| Variables | Univariable | Multivariable | ||||
|---|---|---|---|---|---|---|
| OR (95% CI) | P value | OR (95% CI) | P value | Sidak P value | ||
| Number of prior surgeries [zero] | ||||||
| One | 0.82 (0.58, 1.2) | 0.3 | 0.77 (0.53, 1.1) | >0.99 | >0.99 | |
| Multiple | 1.2 (0.65, 2.6) | 0.5 | 1.01 (0.47, 2.1) | 0.2 | 0.6 | |
| BMI (kg/m2) | 1.02 (0.99, 1.04) | 0.07 | 1.02 (1.00, 1.05) | 0.04 | 0.2 | |
| Age (years) | 1.00 (0.99, 1.02) | 0.4 | ||||
| CCI | 1.08 (1.03, 1.1) | <0.001 | 1.08 (1.04, 1.1) | <0.001 | 0.002 | |
| Sex [female] | 0.86 (0.64, 1.2) | 0.3 | – | – | – | |
| Ethnicity [Hispanic] | 0.94 (0.62, 1.4) | 0.8 | – | – | – | |
| Surgery type [TKA] | 0.99 (0.73, 1.3) | >0.99 | – | – | – | |
| Race [Black] | ||||||
| White | 0.79 (0.55, 1.1) | 0.2 | – | – | – | |
| Other | 0.57 (0.32, 1.01) | 0.052 | – | – | – | |
| Days since most recent prior surgery | 1.00 (0.99, 1.004) | 0.3 | 1.00 (0.99, 1.004) | 0.3 | 0.3 | |
| BMI (kg/m2) | 1.03 (0.95, 1.1) | 0.4 | – | – | – | |
| Age (years) | 0.99 (0.96, 1.02) | 0.5 | – | – | – | |
| CCI | 1.01 (0.97, 1.05) | 0.6 | – | – | – | |
| Sex [female] | 0.96 (0.54, 1.7) | 0.9 | – | – | – | |
| Ethnicity [Hispanic] | 0.59 (0.21, 1.7) | 0.3 | – | – | – | |
| Surgery type [TKA] | 1.2 (0.67, 2.2) | 0.5 | – | – | – | |
| Race [Black] | ||||||
| White | 1.66 (0.85, 3.6) | 0.5 | – | – | – | |
| Other | 0.67 (0.18, 2.1) | 0.2 | – | – | – | |
| Time since most recent prior surgery [6–12 months] | ||||||
| 3–6 months | 0.44 (0.18, 1.08) | 0.07 | 0.44 (0.18, 1.08) | 0.07 | 0.1 | |
| 0–3 months | 1.1 (0.63, 2.1) | 0.7 | 1.1 (0.63, 2.1) | 0.7 | 0.9 | |
| BMI (kg/m2) | 1.03 (0.95, 1.1) | 0.4 | – | – | – | |
| Age (years) | 0.99 (0.96, 1.02) | 0.5 | – | – | – | |
| CCI | 1.01 (0.97, 1.05) | 0.6 | – | – | – | |
| Sex [female] | 0.96 (0.54, 1.7) | 0.9 | – | – | – | |
| Ethnicity [Hispanic] | 0.59 (0.21, 1.7) | 0.3 | – | – | – | |
| Surgery type [TKA] | 1.2 (0.67, 2.2) | 0.5 | – | – | – | |
| Race [Black] | ||||||
| White | 1.2 (0.53, 2.8) | 0.7 | – | – | – | |
| Other | 0.65 (0.16, 2.6) | 0.5 | – | – | – | |
Variables in brackets were used as reference for univariable and multivariable statistics. BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; OR, odds ratio; TKA, total knee arthroplasty.
Discussion
This study investigated the relationship between surgical history, including number and timing within the year, and its effect on TJA postoperative outcomes. These findings suggest that the number of previous surgeries within the year and their respective timing is not associated with an increased risk of postoperative complications following TJA.
The results of this study are consistent with previous, albeit limited, studies that did not establish a significant association between the number of prior surgeries and postoperative complications following TJA (21-23). This finding may suggest that patients with a history of recent surgeries (both orthopaedic and non-orthopaedic) may safely undergo TJA without an increased risk of complications. Interestingly, this study also found that patients without prior surgery within the previous year had greater odds of experiencing a postoperative complication than those with one prior surgery within the year. We suspect this counterintuitive finding likely reflects selection bias. Patients who undergo a prior procedure and then proceed to another surgery within a year may represent a subgroup that has already demonstrated physiologic reserve and the ability to tolerate surgery without an adverse event. In contrast, patients who experience a complication after an initial operation are less likely to undergo a subsequent procedure within the following year, either due to patient preference or surgeon recommendation, which would preferentially enrich the study group of one prior surgery with lower risk patients. This relationship may also be influenced by unmeasured confounding that is not fully captured in the data. Thus, while statistically significant, the finding should be interpreted in the context of these selection effects.
Another major conclusion from this study is that the time from most recent surgery did not have an impact on the odds of having a postoperative complication. This finding adds an interesting point of discussion as it contrasts with prior studies, and current practice belief that timing between a patient’s most recent surgery and a subsequent TJA impacts the likelihood of postoperative complications. Ghasemi et al. found a significant increase in complication rates in patients who underwent staged bilateral TKA within 30 to 90 days (24). Another study concluded that staging a second THA more than a year apart from the first yielded a lower rate of adverse effects (25). Together, these studies did not reach the same conclusion on the optimal timing between surgeries, ranging from one week to a few months (1,8-11,24-26). The discrepancy from the present study could be attributed to the broad types of previous surgeries included. Previous studies were focused solely on orthopaedic procedures, while this study considers all surgeries under general and spinal anesthesia.
While these findings provide general guidelines based on a patient’s recent surgical history, they cannot be extrapolated to all patients. Previous studies have established that patients with preoperative anemia or without adequate nutrition have poorer outcomes following major surgery, including TJA (27-30). These patients may benefit from longer waiting periods to become medically optimized for elective orthopaedic surgery. The decision to undergo TJA is ultimately multifactorial, and factors other than a patient’s recent surgical history should be considered to ensure optimal patient outcomes.
The findings of the study should be interpreted in the context of its limitations. First, this is a retrospective study, subjecting these results to all intrinsic limitations of retrospective study designs. Second, 357 (11.3%) of our large cohort of patients experienced a postoperative complication or readmission. The relatively low positive outcome rates from the viewpoint of statistical model building somewhat limit the utility of the models. The study had insufficient power to look at complication rates based on the specific type of previous surgery, for example, orthopaedic versus non-orthopaedic procedures. Future studies should investigate whether the type of previous surgery affects TJA postoperative outcomes. Despite these limitations, this study provides useful information for both surgeons and patients regarding their risk of complications following TJA in the context of surgical history.
Conclusions
This study demonstrated no association between the number of previous surgeries within the year or timeframe from the most recent surgery and complication rates following primary TJA. These data can be used as supporting information for surgeons to guide and advise their patients regarding their risk for complications following a primary TJA.
Acknowledgments
None.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-59/rc
Data Sharing Statement: Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-59/dss
Peer Review File: Available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-59/prf
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-59/coif). N.B. serves as an unpaid editorial board member of Annals of Joint from July 2024 to December 2026. He also received consulting fees from Microport, Corin, Link, and Depuy. He received royalties from Microport, Corin, Link, and Signature. He has patents with Microport. He has ownership in MSKAI. He is on the American Academy of Orthopaedic Surgeons Orthopaedic Knowledge Update (AAOS OKU), JOA, AOJ, and Arthroplasty Today boards. H.R. is on the editorial board for Orthopedics and The Journal of Arthroplasty, and is a member of the AAOS Adult Hip Program Committee as well as the American Association of Hip and Knee Surgeons (AAHKS) Evidence-Based Medicine Committee. He also serves as an Oral Examiner for the American Board of Orthopaedic Surgery. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional review board of Loyola University Medical Center (No. 215491) and individual consent for this retrospective analysis was waived.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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Cite this article as: Shimizu M, Estrada D, House H, Tate JP, Hand R, DeRolf T, Brown N, Rees H. The impact of past surgical history on postoperative outcomes following primary total joint arthroplasty: a retrospective study. Ann Jt 2026;11:18.
